The 2018 eHealth year in review: part four

Written by Kate McDonald on 21 December 2018.

As the eHealth year moved into its final quarter, the interminable progress of the My Health Record towards broad coverage of the Australian population was again a lowlight. Up in Queensland, rumours were flying about the outcome of an audit into its integrated electronic medical record (ieMR), allied to suspicion over the restricted tender it issued for the long-awaited, high-profile replacement of the HBCIS patient administration system. We also had a chat to Telstra Health's Mary Foley, and looked deeper into the growing concern over the RACGP's agreement with Hello Health.

In the meantime, Western Victoria PHN got the SafeScript trial underway, going live in 400 sites in Ararat, Ballarat, Geelong, Maryborough, Stawell and Warrnambool. The system, built by Fred IT using its eRx Script Exchange system in partnership with MediSecure, will be rolled out to the rest of the state next year and will be mandatory for doctors, pharmacists and nurse practitioners to use from April 2020. In addition to Schedule 8 controlled drugs, Schedule 4 drugs of addiction and sleeping pills, the system will also track codeine prescriptions.

In October, one of the few pieces of academic research on patient and provider experiences with the My Health Record was published. The survey, developed by Charles Sturt University PhD candidate Urooj Raza Khan took place last year and included 179 patients and 51 providers. It found that only 91 out of 230 participants had interacted with MyHR in some way and 150 people either had not heard of it or hadn't used it.

Low uptake of the system over the last six years by patients and providers was one of the main reasons for moving it to opt out and creating a record for the vast bulk of Australians. Antipathy towards the system, particularly from the privacy lobby, kept the issue bubbling away as another deadline approached in November. In October, extra privacy provisions were added to the My Health Record Act and the legislation passed, but Labor and Greens members of the Senate community affairs committee said they would move more amendments in future. The Greens also wanted the opt-out period extended, while Labor wanted it suspended for a year. The victory in the Wentworth by-election of Kerryn Phelps, who opposes the system, also kept it on the front pages.

The committee then released a report from its inquiry into the system implementation, and came up with a whole host of recommended changes, not the least of which was that the opt-out period be extended for a further 12 months, The Coalition Senators on the committee issued a dissenting report, saying a year-long extension was excessive and unnecessary, and reminding opposition Senators that they had all voted unanimously for opt out in 2015. The government did not have to accept the recommendations and didn't, although it eventually acceded to a number of them.

In late October, the government again refused to extend the opt-out period, with the Department of Health reporting at Senate estimates that the rate of people opting out had slowed. However, the government then backed down on its rejection of the Senate committee recommendations, and decided to accept most of them and increase penalties for misuse. Then in appalling scenes in mid-November, as the deadline for opt out again approached and it looked like the opposition would get the numbers in the Senate to force changes to legislation, the government did a deal with One Nation and opt-out was extended to January 31.

While chaos reigned in Canberra, we revealed that up in the Sunshine State, Queensland Health had issued a restricted tender for the replacement of HBCIS, which is expected to cost over $200m. Some were none too happy about it not going to open tender, but Queensland Health argues that the project is incredibly complex and only a few companies have the capability. The shortlist is down to Cerner and DXC, with the former appearing to be the favourite as it provides the state's EMR, but the latter having the vast bulk of the Australian and New Zealand market for PAS and long experience with integration.

In the meantime, the Cerner ieMR came under increased scrutiny this year. Gossip has raged about the Cerner system for close to a decade in Queensland and it didn't let up this year. Back in June, the government announced that it wants 27 hospitals to be on the digital hospital stack by 2020, an ambitious enough target. While the roll-out of the system at Princess Alexandra Hospital has gone quite smoothly, the same can't be said for Cairns Hospital, which was originally chosen as an “exemplar” alongside PAH. Cairns has yet to roll out the advanced version. Queensland's newest hospital, Sunshine Coast University, then announced it would delay its implementation until the new year, citing a need to better prepare its clinicians for the system.

Gossip continued to bubble away, particularly over allegations that the state's Crime and Corruption Commission was investigating the Cerner procurement and the role played by eHealth Queensland CEO Richard Ashby. In December, the Queensland Audit Office released a much-anticipated report that showed the cost of the entire ieMR implementation had been underestimated, mainly due to the extra resources each HHS would have to put into it. Pulse+IT reported on that back in 2015 and in 2017 but were assured everything was hunky dory and that it was extra functionality that had caused the cost increase. The QAO agreed with this, but also found that despite some spruiking by Dr Ashby and his team, the roll out so far has been slow to realise its promised benefits.

The Australian Department of Defence announced new details of its huge JP2060 Health Knowledge Management project, which will eventually involve an EMR covering deployed and garrison staff that reaches at least level five on the HIMSS EMR adoption model, although Defence is hoping for six. The cost is also vast, with an estimated price tag between $150 and $350 million. The first stage of the project will be the replacement of the EMIS primary care clinical information system, which was only rolled out a couple of years ago by DXC. Defence plans to use a system integrator approach to the overall project, selecting a panel of potential lead firms.

In November, we caught up with Telstra Health's Mary Foley not long after the Northern Beaches Hospital in Sydney opened its doors. There hadn't been much publicity about it but TH is providing its Emerging Systems EMR to Healthscope for the hospital, having invested a lot of money in developing it over the last few years. While everything that could go wrong for the hospital did go wrong when it opened, the EMR itself seems to be chugging along quite nicely. Dr Foley also opened up about Telstra Health's highlights, such as Fred IT's winning ways, and its lowlights, such as the National Cancer Screening Register. (Dr Foley rejected that description, saying the company was proud of the work it had done on the NCSR.) As is often the case, anything story onTelstra Health is sure to prove popular, and so it was this year, with the story the most read of all on Pulse+IT for 2018.

As the year in eHealth drew to a close, the move by the RACGP to get into bed with Canadian vendor Myca Health continued to annoy people. All of the gossip has been about the college sending a delegation to the US to seek out a vendor to partner with, but the college rejected that notion. It also rejected the claim it was being paid by Hello Health to send out promotional material on its behalf. The vendor community remained unimpressed, miffed and mystified about why the college did not approach an existing vendor to work with. Best Practice founder Frank Pyefinch then decided to niggle the college by running a survey to gauge what the industry – and the end users – actually thought about it all.

It has been a jam-packed year in eHealth in Australia and New Zealand, with next year shaping up similarly. Pulse+IT will be back in January to continue the ride.

Primary care

Primary Health Care's move to allow its practices to use appointments immediately bore fruit, with the publicly listed company announcing it had increased gross billings per hour compared to the walk-in model. Primary plans to convert all of its practices to the new model next year as it moves to a single practice management system. Some practices have moved off Medtech32 this year and onto MedicalDirector Clinical. However, the adoption of MD's cloud-based Helix system will take a little longer than expected.

Genie Solutions announced it was quite advanced with its plans to develop patient portal functionality for its specialist users, investing $6.5 million into the initiative, which will feature pre-treatment forms functionality followed by appointment bookings and billings, and eventually the ability for practices to monitor patient-reported outcomes and experiences. Genie also launched a cloud-based module for obstetricians as part of its Gentu cloud PMS.

Acute care

Allscripts made some adjustments to its BOSSnet digital medical record for WA clinicians to give them a read-only view of the My Health Record. While some other jurisdictions are using the HIPS middleware solution to connect to the national system, Allscripts has done the work internally to enable BOSSnet to directly integrate with the MyHR and the HI Service. WA uses its statewide Notification and Clinical Summaries (NaCS) system to write and manage discharge summaries.

HISA's Health Data Analytics conference in Melbourne in late October was a bit of a revelation, with some hospital services reporting they were actually making good of their EMRs. Sydney Children's Hospital Network told the conference it was running a proof of concept study analysing real-time data from its Cerner EMR on paediatric oncology patients and their risk of infection, while Royal Children's Hospital in Melboure was analysing data from its Epic EMR to phase out low-value care.

Often the forgotten people of the eHealth sector, the health information management workforce got a boost this year with the first ever census of who and what the workforce entails. Releasing the results of the census at HIMAA's conference in Hobart in November, researchers Kerryn Butler-Henderson and Kathleen Gray said there were ramifications in the age of the workforce for the health system, which is increasingly becoming more reliant on digital health data to deliver patient care. Another census will be held in two years.

Aged care

It was a difficult year for the aged and community care sector, with the residential aged care industry coming under intense scrutiny and an eventual Royal Commission, and community care dogged by the long waiting lists for the NDIS. Earlier in the year WA-headquartered provider Silver Chain announced it was trialling a prototype of Microsoft's HoloLens mixed reality headset to provide healthcare in the home for clients in remote regions of WA. It later announced it had teamed up with the two Perth primary health networks to develop a new model of care for older people living at home, supported by its enhanced medical mixed reality (EMMR) technology.

Irish patient infotainment vendor Oneview Healthcare announced it was entering the aged care market with its first implementation at the new 120-bed Thomas Holt facility at Kirrawee in Sydney. Oneview's aged care solution includes a senior-friendly interface through which residents can view personalised entertainment, calendars, and communicate with family.

Some of the more interesting software, apps and new players in the market that caught our eye this quarter included:

Medical practice software vendor Zedmed announced it was about to roll out a new release featuring improved functionality and performance and a new look. Zedmed is also working on a new app for doctors, allowing them to view appointments, see clinical histories, access results and recall patients. It should be available early next year.

Brisbane medication dosing specialist DoseMe was in the news, having been acquired by US firm Tabula Rasa HealthCare. DoseMe sees its future in the massive US market, with its software now integrated with Epic and Cerner.

Another start-up in Vantari VR is doing interesting things using virtual reality to train junior doctors and for surgeons to plan their operations. It is also set to go into a trial next year to see if it can help with patient understanding of their procedure.